As a responsibility of our profession, physicians are obligated to provide self regulation to ensure that we continue to meet the expectations and secure the trust of our patients. The public, insurers, the federal government, and other stakeholders have asked physicians and the health care systems in which we work for improved quality and better value. But from studies assessing the quality of health care in the United States, there are data indicating that a significant proportion of patients fail to receive the recommended preventative care or care for acute and chronic conditions.1 Additionally, there is growing evidence that physician knowledge and quality of care decline the longer a physician remains in practice.2 In fact, a recent study of Canadian anesthesiologists indicated that the frequency of litigation and the severity of injury with adverse events were greater in patients cared for by anesthesiologists older than 65 compared to those who were younger than
51 years of age.3

It appears that once physicians leave training, some do not continue to learn and keep up to date with changes in best practices. In response to these concerns and to focus on the principles of continuous lifelong learning and practice assessment and performance improvement, the American Board of Medical Specialties (ABMS) has adopted the concept of Maintenance of Certification (MOC) for all of its 24 member boards. Therefore, in 2000 the American Board of Anesthesiology (ABA) began to issue time-limited certificates to its diplomates as part of Maintenance of Certification in Anesthesiology (MOCA®). The ABA is free to determine the requirements for MOCA® within the framework set by ABMS, but the specifics must be approved by ABMS.

Although maintenance of certification has been part of the landscape for physicians for more than a decade, it remains a concept that is frequently debated among its strong supporters and critics.4 Those who champion maintenance of certification believe it is an essential process to demonstrate to the public that participating physicians are working to maintain competence while opponents focus on the time required for completion of the requirements as well as the additional expense, frequently citing there is no evidence that it is effective in producing meaningful change.

MOCA® consists of four parts, including Licensure and Professional Standing (Part 1), Lifelong Learning and Self-Assessment (Part 2), a secure Cognitive Examination
(Part 3), and Practice Performance Assessment and Improvement (Part 4). The MOCA® process is a 10-year cycle with specific requirements for diplomates based on the original year of certification. If all the MOCA® requirements are not successfully completed by the end of the 10-year cycle (there is a three-year grace period beyond the 10 years to complete all requirements), the time-limited certification will expire and the anesthesiologist will no longer be board-certified. Specific information regarding MOCA® can be found on the ABA website at http://www.theaba.org/Home/anesthesiology_maintenance. More than 18,700 anesthesiologists have enrolled in MOCA® (almost 1,900 of these have non-time limited certification and are voluntarily participating in MOCA®), and more than 3,000 have already completed their first MOCA® cycle.

One of ASA’s core missions is education, and our strategic plan clearly sets a goal of developing the education activities needed by our members. Through the work of numerous ASA members serving on our editorial boards and staff from the ASA Education Department, the necessary education activities have been developed for anesthesiologists to complete the Part 2 and 4 MOCA® requirements set by ABA. (Table 1) Information about these products can be accessed on our Web-based Education Center, and many of the education activities can be completed online.

The ABA is one of two ABMS boards that require simulation as part of maintenance of certification. Data from participants completing the mannequin-based MOCA® simulation courses overwhelmingly demonstrate that the content was relevant to their practices and would result in changes.5

For the past several years, ASA has focused on developing the education activities needed by our members to meet their MOCA® requirements. Recognizing that the clinical practices of anesthesiologists are quite diverse, ASA will continue to expand its education offerings, including those for MOCA® for subspecialists.

Arnold J. Berry, M.D., M.P.H. is Professor
of Anesthesiology, Director, Office of
Continuing Medical Education, and Assistant Dean for Education, Emory University School of Medicine, Atlanta.